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Comparative study of methodologies for pulse wave velocity estimation

Abstract

Arterial stiffness, estimated by pulse wave velocity (PWV), is an independent predictor of cardiovascular mortality and morbidity. However, the clinical applicability of these measurements and the elaboration of reference PWV values are difficult due to differences between the various devices used. In a population of 50 subjects aged 20–84 years, we compared PWV measurements with three frequently used devices: the Complior and the PulsePen, both of which determine aortic PWV as the delay between carotid and femoral pressure wave and the PulseTrace, which estimates the Stiffness Index (SI) by analyzing photoplethysmographic waves acquired on the fingertip. PWV was measured twice by each device. Coefficient of variation of PWV was 12.3, 12.4 and 14.5% for PulsePen, Complior and PulseTrace, respectively. These measurements were compared with the reference method, that is, a simultaneous acquisition of pressure waves using two tonometers. High correlation coefficients with the reference method were observed for PulsePen (r=0.99) and Complior (r=0.83), whereas for PulseTrace correlation with the reference method was much lower (r=0.55). Upon Bland–Altman analysis, mean differences of values±2s.d. versus the reference method were −0.15±0.62 m/s, 2.09±2.68 m/s and −1.12±4.92 m/s, for PulsePen, Complior and PulseTrace, respectively. This study confirms the reliability of Complior and PulsePen devices in estimating PWV, while the SI determined by the PulseTrace device was found to be inappropriate as a surrogate of PWV. The present results indicate the urgent need for evaluation and comparison of the different devices to standardize PWV measurements and establish reference values.

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References

  1. O'Rourke MF, Mancia G . Arterial stiffness. J Hypertens 1999; 17: 1–4.

    Article  CAS  PubMed  Google Scholar 

  2. Nichols WW, O'Rourke MF . McDonald's Blood Flow in Arteries. Theoretical, Experimental and Clinical Principles, 5th edn. Hodder Arnold: London, 2005, pp 49–93, 339–367.

    Google Scholar 

  3. Benetos A, Adamopoulos C, Bureau JM, Temmar M, Labat C, Bean K et al. Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period. Circulation 2002; 105: 1202–1207.

    Article  PubMed  Google Scholar 

  4. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001; 37: 1236–1241.

    Article  CAS  PubMed  Google Scholar 

  5. Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME . Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol 2001; 21: 2046–2050.

    Article  CAS  PubMed  Google Scholar 

  6. O'Rourke MF, Steassen JA, Vlachopoulos C, Duprez D, Plante GE . Clinical applications of arterial stiffness: definitions and reference values. Am J Hypertens 2002; 15: 426–444.

    Article  PubMed  Google Scholar 

  7. Sutton-Tyrrel K, Mackey RH, Holubkov R, Vaitkevicius PV, Spurgeon HA, Lakatta EG . Measurement variation of aortic pulse wave velocity in the elderly. Am J Hypertens 2001; 14: 463–468.

    Article  Google Scholar 

  8. Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR et al. Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis. J Hypertens 1998; 16: 2079–2084.

    Article  CAS  PubMed  Google Scholar 

  9. Chiu YC, Arand PW, Shroff SG, Feldman T, Carrol JD . Determination of pulse wave velocities with computerized algorithms. Am Heart J 1991; 121: 1460–1470.

    Article  CAS  PubMed  Google Scholar 

  10. Safar M . Therapeutic trials and large arteries in hypertension. Am Heart J 1988; 115: 702–710.

    Article  CAS  PubMed  Google Scholar 

  11. Blacher J, Asmar R, Djane S, London G, Safar ME . Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999; 33: 1111–1117.

    Article  CAS  PubMed  Google Scholar 

  12. Blacher J, Guerin A, Pannier B, Marchais S, Safar M, London G . Impact of aortic stiffness on survival in and-stage renal failure. Circulation 1999; 99: 2434–2439.

    Article  CAS  PubMed  Google Scholar 

  13. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al. 2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of arterial hypertension. J Hypertension 2007; 25: 1105–1187.

    Article  CAS  Google Scholar 

  14. Drzewiecki GM, Melbin J, Noordergraaf A . Arterial tonometry: review and analysis. J Biomech 1983; 16: 141–152.

    Article  CAS  PubMed  Google Scholar 

  15. Matthys K, Verdonck P . Development and modelling of arterial applanation tonometry: a review. Technol Health Care 2002; 10: 65–76.

    PubMed  Google Scholar 

  16. Pressman GL, Newgard PM . A transducer for the continuous external measurement of arterial blood pressure. IEEE Trans Biomed Eng 1963; 10: 73–81.

    CAS  PubMed  Google Scholar 

  17. Mackay RS, Marg E, Oechsly R . Automatic tonometer with exact theory: various biological applications. Science 1960; 131: 1668–1669.

    Article  CAS  PubMed  Google Scholar 

  18. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995; 26: 485–490.

    Article  CAS  PubMed  Google Scholar 

  19. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eu Heart J 2006; 27: 2588–2605.

    Article  Google Scholar 

  20. Mackenzie IS, Wilkinson IB, Cockcroft JR . Assessment of arterial stiffness in clinical practice. Q J Med 2002; 95: 67–74.

    Article  CAS  Google Scholar 

  21. Pannier BM, Avolio AP, Hoeks A, Mancia G, Takazawa K . Methods and devices for measuring arterial compliance in humans. Am J Hypertens 2002; 15: 743–753.

    Article  PubMed  Google Scholar 

  22. Schmitz CH, Graber HL, Barbour RL . Peripheral vascular noninvasive measurements. In: JG Webster (ed). Encyclopedia of Medical Devices and Instrumentation, 2nd edn. Wiley Publisher: New York, 2006, pp 234–252.

    Google Scholar 

  23. Millasseau SC, Guigui FG, Kelly RP, Prasad K, Cockcroft JR, Ritter JM et al. Non-invasive assessment of the digital volume pulse: comparison with the peripheral pressure pulse. Hypertension 2000; 36: 952–956.

    Article  CAS  PubMed  Google Scholar 

  24. Millasseau SC, Kelly RP, Ritter M, Chwienczyk PJ . Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Cli Sci 2002; 103: 371–377.

    Article  CAS  Google Scholar 

  25. Chwienczyk PJ, Kelly RP, MacCallum H, Millasseau SC, Andersson TLG, Goslin RG et al. Photoplethysmographic assessment of pulse wave reflection: blunted endothelium-dependent response to beta2 adrenergic vasodilation in type II diabetes. J Am Coll Cardiol 1999; 34: 2007–2014.

    Article  Google Scholar 

  26. 41st World Medical Assembly. Declaration of Helsinki: recommendations guiding physicians in biomedical research involving human subjects. Bull Pan Am Health Org 1990; 24: 606–609.

  27. Salvi P, Lio G, Labat C, Ricci E, Pannier B, Benetos A . Validation of a new non-invasive tonometer for determining arterial pressure wave and pulse wave velocity: the PulsePen device. J Hypertens 2004; 22: 2285–2293.

    Article  CAS  PubMed  Google Scholar 

  28. Othmane TE, Bakonyi G, Egresits J, Fekete BC, Fodor E, Jarai Z et al. Effect of sevelamer on aortic pulse wave velocity in patients on hemodialysis: a prospective observational study. Hemodial Int 2007; 11: S13–S21.

    Article  Google Scholar 

  29. Quan H, Shih WJ . Assessing reproducibility by the within-subject coefficient of variation with random effects models. Biometrics 1996; 52: 1195–1203.

    Article  CAS  PubMed  Google Scholar 

  30. Bland JM, Altman DG . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; i: 307–310.

    Article  Google Scholar 

  31. Millasseau S, Stewart AD, Patel SJ, Redwood SR, Chwienczyk PJ . Evaluation of carotid–femoral pulse wave velocity. Influence of timing algorithm and heart rate. Hypertension 2005; 45: 222–226.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study has been financed by the National Institute of Health (INSERM) and the University of Nancy.

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Correspondence to A Benetos.

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Salvi, P., Magnani, E., Valbusa, F. et al. Comparative study of methodologies for pulse wave velocity estimation. J Hum Hypertens 22, 669–677 (2008). https://doi.org/10.1038/jhh.2008.42

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